Bronchopulmonary therapeutic apparatus



Aug. 5, 1958 R. DENTON 2,845,928.

BRONCHOPULMONARYI THERAPEUTIC APPARATUS Filed Jan-. 28, 1953 4Sheets-Sheet 1 22 24 J 82' Q as 4 FIG. RQBERT BENTON INVENTOR.

Aug. 5, 1958 R. DENTON BRCNCHOPULMONARY THERAPEUTiZC APPARATUS 4Sheets-Sheet 2 Filed Jan. 28, .1953

ISBb s FIG. 7

ROBERT DENTON INVENTOR.

FIG. 6

romvs Y Aug. 5, 1958 R. DENTON 2,

BRONCHOPULMONARY THERAPEUTIC APPARATUS Filed Jan. 28, 1953 4Sheets-Sheet 3.

INSPIRATION ROBERT DEN r0/v INVENTOR.

R. YDENTON BRONCi-IOPULMONARY THERAPEUTIC APPARATUS Filed Jan. 28, 1953Aug. 5, 1958 4 Sheets-Sheet 4 United States Patent BRONCHOPULMONARYTHERAPEUTIC APPARATUS Robert Denton, Oakland, Calif., assignor to MistoGen Equipment Co., Oakland, Calif., a corporation of California Thisinvention relates to techniques of treatment for medical patientssuffering from primary and/ or secondary ailments involving one or moreof the components of the respiratory system. This application is acontinuation in part of my copending application Ser. No. 287,344 filedMay 12, 1952, and now abandoned.

Techniques of treatment of the bronchial system include one involved andimproved upon by this invention and known in the art as aerosol therapywhich refers to the utilization of a gas, such as air or pure oxygen, asone component of a vehicle for the application to the membranes liningthe respiratory tract of a medicinal agent such as the antibioticpenicillin or a shrinking agent, another component of the vehicle beingwater in which the medicinal agent is initially dissolved so that themedicine in solution may be carried therein to and deposited on theinfected areas of the upper and lower respiratory tract portions. Bothof these vehicles are, as will be evident, essential and of medicinal ortherapeutic significance to the patient in addition to their vehicularcapacity in the therapy.

The action in generating aerosol is provided in part by means of aninstrument known as a nebulizer. This instrument utilizes air or anothergas for breaking the liquid body or solution into drops small enough tobe mixed and to be carried by the gas and/or air into the lungs. Thenebulizer applies the gas to a water solution of drugs to form the dropsand to form the mixture by utilizing expansive energy pre-stored in thegas by compression. The liquid is, incident to operation upon it by thegas and the nebulizer, translated partly to the vapor state and partlyto the suspended liquid state in droplet form known as supersaturationof the gas with the liquid.

In addition to the specific types of problems of treatment for theapplication of nebulized-liquid-oxygen to various types of normal cases,there is the special one characterized by the tracheotomized patient whois also confined in a mechanical respirator, popularly known as the IronLung. A tracheotomized patient is one provided with an opening at thebase of his throat adjoining the chest which opening by-passes thethroat, nose and mouth to atmosphere and being usually employed becauseof the incapacity of these organs to function in a normal manner, as inthe case of many poliomyelitis patients. The hole through the throat istermed a tracheal opening. In by-passing the throat and the nose,inspiration through the tracheal opening eliminates even the possibilitythat the inspired air will be moistened in the nose and in the throat asit is usually moistened naturally. Dry room air or dry oxygen passingdirectly into the trachea and bronchial tree is responsible for severedamage to the entire respiratory tract. If this type of patient retainsthe lung and diaphragm power to breath naturally he can be given oxygentherapy in a tent of the open top type. Those who are unable to breathunder their own power are placed in the mechanical respirator. Thephysical structure of a mechanical respirator is such that the tent2,845,928 Patented Aug. 5,1958

cannot be readily accommodated to the patient in such a manner that thenebulized-liquid-oxygen atmosphere can easily be applied to the trachealopening and at the same time exclude air. By apparatus for the purposeherein described the same treatment that persons not confined to therespirator receive may in the essentials be provided for therespiratorized patient who must have oxygen and moisture pumped into andout of his lungs via the tracheal opening to maintain the normalfunction of the lungs to support life.

It is therefore an object of this invention to provide apparatus forapplying a medicinal atmosphere to a tracheotomized patient.

Other objects and advantages of the invention will become evident from aconsideration of the following description wherein reference is made tothe accompanying drawings, in which:

Fig. 1 is a fragmentary elevational view, partially in section, of anebulizer, to which there have been added certain features ofconstruction;

Fig. 2 is a section at line 2-2 of Fig. 1 restricted to element 38thereof;

Fig. 3 is a fragmentary section along the upper end of line 33 of Fig.1; 1

Fig. 4 is an enlargement of the jet apparatus;

Figs. 5, 6, and 7 illustrate details of the apparatus of this invention;

Figs. 8 and 9 illustrate in a somewhat diagrammatic manner the path ofaerosol taken during operation of the apparatus;

Fig. 10 is a top plan view of a modified form of a tracheotomy aerosoladministering apparatus for patients who must be moved;

Fig. 11 is a cross-sectional view taken along line 11-11 of Fig. 10; and

Fig. 12 is a cross-sectional view similar to Fig. '11 but showing afurther modification thereof.

The aerosol nebulizer apparatus is shown to include a suitable glassvessel or jar 10 having a screw threaded neck 12. For attachment to theneck 12 there is provided a cast metal body 14 having several functionalfeatures. The body 14 provides a jar cover portion 16 which is formed tofit the jar neck 12 and to form a seal with it. Body 14 further providesa cup portion .18 defining an injection, nebulizing, mixing, separatingand expansion chamber 20. The cover and cup portions include a commontop and bottom partition 22 having a drain opening 24 for theequalization of pressures within the jar and the chamber 20 and for thereturn of condensed liquid collected in chamber 20.

The body 14 is further provided with an opening v26 concentric upon anaxis (horizontal in the drawing) substantially perpendicular to thecommon vertical axis of the jar and'cover. An annular supporting ring 28is formed integral with the cup wall and surrounds opening 26 on theinside of the cup. The opening 26 is disposed at a substantial distanceabove the bottom of the cup and the bottom portion 22 of the cup isjoined to the wall and ring by a boss 30. A vertical cylindrical hole32' having its axis parallel to the axis of the cover 16 is disposedthrough the boss 30 inside the ring 28, and the integral portionstherewith of the bottom cover 22, for the reception of a draft tube 34.The upper rim of cup 18 is cylindrical and provides a fiat rim 36 in aplane perpendicular to the cup axis.

A dispensing nozzle 38 (Figs. 1, 2) is provided to release the cloud ofnebulae from chamber 20 into the surrounding atmosphere, or to thetracheotomy attach ment to be described. Nozzle 38 comprises a coverportion 40 having an annular externally cylindrical skirt 42 forrotatable reception and adjustment Within the rim of cup 18 and has anannular shoulder 44 to abut the rim 36. The skirt 42 is further providedwith .a peripheral groove 46 into which the ends of two or more screws48, threaded through the wall of cup 18, project for detaining andsecuring the nozzle 30 in any .angular position on the cuprim.

Nozzle 38 is further provided with a relatively large off-center passage50 through the flat portion 52 of the cover. A domelike deflector 54 isformed integrally with the cover portion 52 around opening 50. Thedeflector terminates in a plane slightly off perpendicular to provideopenings 56 through a suitable grid of parallel bars 58. It will beobserved that this nozzle provides relatively free passage of themixture of gas and nebulized solution from the chamber 20 through itsoutlet.

A thin-walled tube 60 is secured to flange Z8 concentric of the opening26 and projects into chamber 20 so as to form a radial opening from tube60 between its free vend 62 and the adjacent wall portion 64 of the cup.Adjacent its secured end, tube 60 is provided with longitudinal notches66 and 66' '(Fig. 3) for the reception and the positioning in opening 26of an assembly comprising an outer body 68 having radial legs 78 and 78the tips of which, in the operation of assembling, slide axially throughopening 26 into the notches and dispose their ends against the inside offlange 28. One notch 66' adjoins the hole 32 and receives a leg 70having a threaded hole therein for the reception of the threaded upperend of the tube 34. The three-port opening formed between flange 28 andbody 68 by legs 70 and 70' and tube 60, permits free flow of atmosphericair or other gas through opening 26 into chamber space 28 and when theunit is disposed inside the open-top tent the oxygenric-h atmospheretherein is recirculated and further charged with the oxygen and theliquid nebulae, thus maintaining a high concentration in the tent.

The body 68 is bored centrally to leave a sleeve portion 72 forreceiving in the outer end of the bore a closely fitted internal sleeve74 having an externally beveled flange '76 abutting the internallybeveled end of the outer sleeve 72 as shown. The sleeves 72 and 74 forman internal chamber 78 with which the passage of tube 34 communicates.The sleeve 72 also provides a nozzle portion 80 having an axialcylindrical hole 82 extending from chamber 78 into tube 60 near itsouter end as shown. The sleeve 74 is of a diameter to position itconcentric inside sleeve 72 and provides a central passageway 84terminated by an internal nozzle base 86. A straight cylindrical tube 88is secured in the nozzle base with its axis coincident with the axis ofhole 82. The tube 88 extends through chamber 78 and to a predetermineddistance into bore 82. The length of the portion of tube 88 within the.bore 82 is siginficant as will be pointed out. This length may beadjusted by filing ofi the tip, or left end as seen in 'Fig. 4, for thepurpose of adjusting the ratio of nebulae to oxygen.

The sleeve 72 is provided with a coupling thread 90 by means of which asuitable coupling to a flexible pressure hose may be attached forsecuring sleeve 74 in place and for conducting oxygen through nozzletube 88.

The bore 82 is preferably circularly cylindrical and the tube 88 islikewise preferably of uniform internal and external diameters. In onesuccessful embodiment of the invention the bore 82 is about 1.313 incheslong and .040 inch in diameter. The outside diameter of tube 88 is about.032 inch and its inside diameter is about .018 inch. Withthe pressureof the oxygen delivered at 84 being in the range from fifteen to onehundred pounds per square inch, the stream of oxygen passing throughtube 88 is restricted to that required by the patient and the minimumlosses occur over the tent top edge. The velocity of the stream ofoxygen as it leaves tube 88 and as it is released to the bore 82surrounding the orifice of tube 88 is very high and maintains a very lowpressure at that region. Accordingly, the liquid solution in vessel isforced by atmospheric pressure, up through tube 34 and into the chamber78 surrounding tube 88, whence it is drawn in the shape of a tubularcolumn of liquid concentrically out and around the central nozzle 88past its tip. The length of tube 88 in the bore 82, and the crosssection and length of this tubular space, determine for the most partthe amount of solution which can pass through its length in unit time,the pressures at the inlet and outlet of this passage being fixed by theoxygen pressure. The pressure conditions, for any particular assembly ofthe parts, are determined by the pressure applied at 84.

With the arrangement as described several bodies 68 having differentsizes of the hole 82, are interchangeably fixed in opening 26. Thisrequires only the removal of cover 14 from vessel 10, and the unscrewingof tube 34 which tube constitutes the mechanical means of securement ofbody 68 in position within ring 28. It is clear that the sleeve 74 withtube 88 may itself be readily replaced by similar sleeves having nozzletube 88 of different dimensions so that different quantities of air andpressures and pressure drops may be provided for, and so that, in thecase of clogging in operation, a swift replacement may be eflected.

In the operation of the nebulizer as such, atmospheric air is drawnthrough part 26 and serves to supplement the requirement for dispersionof the droplets of solution into the atmosphere as the droplets areformed. The formation is greatly facilitated because the gas is releasedinside the moving tube of liquid solution escaping from the hole 82 andexpands rapidly and radially in rupturing the thin tubular film ofconcentric solution.

The entire unit shown in Figs. 1 to 4 is, as hereinafter described,placed in the tent occupied by the patient. By this method ofadministration the freed previously treated supersaturated oxygen-richatmosphere within the tent is continually being drawn into the inlet at26 and into tube 60. Thus, the treated atmosphere within the tent isfree of unnecessary dilution, from which it would not be free werepreviously untreated atmosphere or air from outside the tent, broughtinto inlet 26.

The provision for entry of a part of the ambient atmosphere throughinlet 26, irrespective of whether the entire device is within the tentor whether it receives air to 26 from outside the tent, benefits themixing process in that it permits adequate flow of aerosol from theoutlet port. The aerosol mixture of oxygen and solution excapes fromnozzle at high velocity in the direction of chamber 20, wall portion 64and the end of tube 62.

The radial expansion of the oxygen tends to throw the small particles ofsolution radially toward, and effectually throws the large ones against,the surrounding inside surface of tube 60. This tendency is, as respectsthe small particles, resisted by the atmosphere aspirated throughopening 26 more effectually than in respect of the large particles dueto their relative areas and masses being more easily influenced. Theambient atmosphere rushes in therethrough, being continually induced tosuch movement by the effect of high velocity fluid escaping at 82. Theaspirated atmosphere serves to disperse the solution in the oxygen andtends to prevent deposit of the small liquid particles on the insidesurface of tube 60. Substantially only the desired small particles of .5micron to 8 microns in diameter, pass upwardly in chamber 20 to outlet50, the larger ones striking the walls of tube 60 or at 64, or whentheir kinetic energy-is spent in some cases, falling to the drain 24.(Note: one micron equals one-millionth of a meter.)

The tube 60 and the chamber formation together perform an additionalfunction which is to give direction to the supersaturated mixture of gasand liquid to cause it to escape at 50, instead of tending merely tocirculate back to the zone of low pressure near nozzle 80.

The tube 62 terminates adjacent wall 64 and the surrounding regionappears to be somewhat above atmospheric pressure so' that flow is inthe direction of the nozzle 54. p

In order to convey the nebulized atmosphere from nebulizer 11 to thetracheal opening in a patient the apparatus hereinafter described isprovided. The apparatus of Figs. 5-7 may be used in connection with amechanical respirator in which the tracheotomized patient is resting andwhich respirator is usually provided with a flexible collar or diaphragmsurrounding the patients neck. Suitable support for the nebulizer 11 maybe provided in the form of an arm 115 (Fig. 5) which maybe secured tothe respirator.

A special tracheotomy oxygen dispensing adapter 143 (Figs. 5-9) for thenebulizer is provided and includes a tube 145 and a conoidal flaredportion 147 joined by the small end thereof to one end of the tube 145.The large end of the flared portion 147 is mechanically formed toreceive quick detachable and attachable support in a relativelygas-tight sealed relation with the discharge openings 56 of thenebulizer unit 11. As shown in Fig. 5, the provisions for these resultsinclude at the lateral sides of lug 139 a pair of upwardly disposed pins149 receivable in holes 149 formed as shown at the top of the end offlared portion 147. The holes receive the pins 149 and the remainder ofthe end of the part 147 rests in sup ported and sealing relation to thehood 38, cover 52 and wall 18 due to the weight of adapter 143. Thissupport is clearly illustrated in Fig. 5 and by reason thereof theentire weight of the tracheotomy adapter 143 is carried on theapparatus, and not by the patients neck in any sensible degree. When itis desired to have the patients neck mobile, other equipment isprovided, as will be described.

The portions 145 and 147 are preferably formed of suitably rigidtransparent plastic material. Transparency is of substantial advantageas will be pointed out, and the plastic material as such beingrelatively infrangible will stand against abusive impacts. The tube 145has a bend at 151 (Fig. 5) therein intermediate its ends and about anapproximately vertical axis as shown in the adapted positions in thedrawings. This bend 151 is provided in order to continue the tube onpast the tracheotomy opening for important reasons to be explained, andbecause the tracheotomy is usually actually near to or within the planeof the collar surrounding the neck opening of the respirator.

At the peak of the bend portion 151 on the bottom or patients sidethereof, the tube wall is provided with an outlet or breathing hole 153,Fig. 5, through which the oxygen-aerosol-gas is drawn by the patientinto the tracheal opening from the tracheotomy adapter tube 143, andthrough which the patient also exhales. Securely cemented in gas sealedrelation to the lower side of the bent portion 151 is a gland blockforming cushion 155 of soft spongy material such as of synthetic rubberwhich will not pass gas through its body except through a holed port 156thereof in registry with the hole 153. The pressure exerted by theapparatus is that only of the expansive force of this gland 155 on thepatients throat around the opening, adjusted by the support for thenebulizer as described. As seen in Figs. 5 through 7 the block 155contacts only the top surface of a Vaseline saturated gauze pad orbandage 158 having a hole 158a therethrough the rim 15812 of which holeis entirely spaced from flange 157a of the tracheotomy tube 157. Thelubricated pad 158 forms a sealing gasket between block 155 and the skinS of the patient around the tracheotomy tube 157. It is important thatthe flange 157:: of the tracheotomy tube be entirely free of contactwith the block 155.

In order to insure to the patient the delivery through the trachealopening of a pure aerosol atmosphere the tube 145 is extended by anextension part 145a beyond the tracheotomy port 153 a substantialdistance to an end 162 thereof which end is open to the atmosphere. Thelength .of this exhaust portion, approximately 'six inches, isdetermined so as to prevent, in great degree, the rehreathing' of lungexpired gases; and secondarily to avoid the dilution of the oxygen withambient atmosphere. These functions are illustrated in Figs. 8 and 9. InFig. 8 it is shown by the arrows that, during the inspiration, oxygenfrom the extended portion of the tube tends to return toward the hole153 but in the main the oxygen in this region serves only as a stopperor buffer against entry of am bient air. Most of the inspired oxygencomes directly through the part of tube on the nebulizer side oftracheotomy port 153. Ambient air at the exhaust end of the tube is thussealed off at almost exactly atmospheric conditions.

In the expiration the expired gases move freely through the exhaust part145a of the tube to atmosphere. However, at the terminal phase ofexpiration, the last volume of expired gas is forced out of the part145a by oxygen from the nebulizer so that only fresh oxygen and vapor(aerosol) remain in the tube 145 for the following inspiration. It willbe observed that recirculation of am bient air through the generatorcorresponding to that when in the tent is not available in thistracheotomy apparatus.

In order to provide a clear space adjoining the tracheal opening, inwhich space the bent portion 151 of the tube may be positioned by theflared end portion 147 thereof as described without interference; and inorder that, in the absence of the adapter, an attendant may have quickaccess into the tracheal opening, the respirator is provided with thestandard deflecting rod 164 (Fig. 5) having a bow shape and the rod isrotatably supported about the coincident substantially horizontal axesof its aligned straight ends in slide blocks which may be 'adjustablyfastened on brackets for movement of the blocks toward and away from therespirator and for rotation of the bowed portion of the rod to force thediaphragm collar into the respirator against the tension therein andthus clear the required access space for access therein by the bentportion 151 of the adapter. The tracheotomy adapter 143 is thusaccommodated to and 'by previously used standard respirator equipment.

Mucous must be removed from time to time to prevent strangulation of thepatient; It will now be appreciated that transparency of the tube 145,particularly at the top side of the bent portion 151, is of importancebecause through this portion and holes 153 and 156 the degree ofaccumulation of such mucous can be observed without interrupting theoperation of the apparatus.

For the respiratorized tracheotomy patients who must be moved about inthe respirator or who can and should be permitted to move their heads, atracheotomy aerosol administering apparatus components are shown inFigs. l0, l1 and 12. In this apparatus the generator 11 may be rigidlymounted at any point nearby but preferably on the respirator. The dometype nozzle 38 shown in Fig. 1 is replaced by a nozzle-like dispensingadapter cover 38' having a tubular nozzle 38a.

An applicator 151 is strapped, by means of a band 151a extending aroundthe patients neck and hooked in hooks 151b of the applicator, against awasher-shaped gauze patch 158, saturated with Vaseline to constitute ita gas impervious packing and lying on the patients throat as a gasketabout the tracheotomy. A sponge contact ring 155' is cemented to thelower end of a tubular portion 1510 of the, applicator 151 and the upperend of the tubular portion 151a includes an inwardly disposed annularflange 151n formed with a flat top surface portion 151m and surroundinga suctioning access part 151d through flange 151n. A transparent windowforming, and flat bottom sealing cover form-ing, member 151e having aflat undersurface and diametrically opposite slots 151i and fasteninglug ports 151g drops over lug heads 151k fastened to the flange 151n asshown, and upon rotation is cammed by heads 151h against the top surface151m. The weight of applicator 151 islargcly carried .by a hook 1510secured rigidly at 151p .to applicator 151', and elastically .suspendedas by .a spring 151! the upper end 15.11 of which is :also fixed to therespirator.

The applicator 151'is provided'with like inlet and outlet tube parts145' and 162' corresponding to parts 145 and 162 of the modification ofFig. 5. Tube 145' and applicator 38' are joined by a flexible plasticgas impermeable tube 145c of uniform interiorly smooth finished section.The tube 145c is held in a tubular shape in any straight or curvedposition by an in-fitted helical coil 14515 of stainless steel wire,thus providing an insured passage of flexible character which is visibleinten'orly to ascertain that it is clear of any obstruction. By reasonof this flexibility the patient may move or be moved readily withoutreadjustment of the generator and without developing unbearablyuncomfortable strains on the patients flesh in the vicinity of thetracheotomy. The stainless steel coil 14% is corrosion proof and thesmooth finish on the inside of the tube allows all condensate to drainas formed so that no dangerously large bodies of condensate collect.

The fiow of aerosol is adjusted to a nicety by means of an adjustablechoke 162c of rubber having a central orifice 162d the diameter of whichmay be increased by drawing the cufi portion 1626 on or oil the bead162i.

In Fig. 12 another form of the applicator is shown. The sponge contactor155" is cemented to strap attachment base 152]) to which band 151a isattached at eyes 151]). The larger mass of the applicator comprisingtube 152c is joined to base 152b through a bellows type joint 152e whichis capable of bending and of expansion up and down. Thus the great massof the applicator is supported by the spring and only the sponge ispartially supported by the patient.

I claim:

1. Apparatus for treating a tracheotomized patient, said apparatuscomprising: an aerosol generator for generating and issuing an eflluentof a mixture of a nebulized liquid in a gas, enclosed conduit meanscommunieating at one end with said generator, having its other end opento the atmosphere, and provided with an outlet intermediate said endswhich outlet may be positioned in communicating relationship with atracheal opening 8 in a patient for continuously conveying said eflluent.to and past said outlet and outwardly of said one end for permittingperiodic introduction of said eifiuent into the patient, said conduitmeans being provided with a trans parent portion adjacent :said outletfor permitting visual observance of said outlet through said portion.

2. Apparatus for treating a tracheotomized patient, said apparatuscomprising: an aerosol generator for generating and issuing an efiluentof a mixture of a nebulized liquid in a gas, enclosed conduit meanscommunicating at one end with said generator, having its other end opento the atmosphere, and provided with an outlet intermediate said endswhich outlet may be positioned in communicating relationship with atracheal opening in a patient for continuously conveying said eflluentto and past said outlet and outwardly of said one end for permittingperiodic introduction of said effiuent into the patient, and gasketmeans surrounding said outlet.

3. Apparatus for treating a tracheotomized patient, said apparatuscomprising: an aerosol generator for generating and issuing an effluentof a mixture of a nebulized liquid in a gas, enclosed conduit meanscommunicating at one end with said generator, having its other end opento the atmosphere, and provided with an outlet intermediate said endswhich outlet may be positioned in communicating relationship with atracheal opening in a patient for continuously conveying said efiluentto and past said outlet and outwardly of said one end for permittingperiodic introduction of said eflluent into the patient, and a variablechoke on said outlet.

References Cited in the file of this patent UNITED STATES PATENTS2,432,946 Theunissen Dec. 16, 1947 2,584,450 Holt Feb. 5, 1952 2,593,134Gibbon Apr. 15, 1952 2,605,764 Adams Aug. 5, 1952 2,624,337 Gibbon Ian.6, 1953 2,699,775 Cameto Jan. 18, 1955 FOREIGN PATENTS 502,531 GreatBritain Mar. 20, 1939

